Rolling the dice: the perils of Quebec’s reopening strategy

"With an epidemic still underway and no plan in sight for the massive scale-up in testing, random sampling, and contact tracing needed to keep the disease spread under control, Quebecers may be the first Canadians to see what a hasty return to work and school can do to a society. No one can reasonably demand a guarantee of success, but citizens should expect their governments to ensure that the odds are on their side."

Public Health Ontario's Toronto lab is pictured. The lab is where the province is testing samples from potential COVID-19 patients to confirm whether they have the illness or not. Steve Russell /Toronto Star

“Let’s just do this.” That seems to be the sentiment behind Quebec’s startling decision to begin relaxing social distancing measures in May, as the pandemic continues to overwhelm the province.

The progressive reopening of industry, retail and — most controversially — elementary schools and daycare centres is bold, to be sure. But is it based on anything more than blind faith and a gambler’s tolerance for high stakes?

In case you haven’t noticed, Quebec is the centre of Canada’s pandemic, with more than half of all cases and almost 60 per cent of all deaths, even though the province accounts for just 22.5 per cent of Canada’s population. Ontario may still be struggling with outbreaks in nursing homes and has shown a consistent failure in testing, but the size of its epidemic is a fraction of Quebec’s.

A single Quebec nursing home, the blighted Ste-Dorothée CHSLD in the Montreal suburb of Laval, has reported 81 deaths, about the same number as all the deaths in Alberta (87) since the start of the pandemic.

The situation in the province’s other nursing and retirement homes is still far from under control, with several hundred facilities reporting outbreaks. Yesterday, a home in Montreal had to urgently be evacuated and its vulnerable patients relocated to a hotel, after most of the staff didn’t turn up for work because of a coronavirus outbreak in the facility.

Messaging from Premier François Legault has framed the acknowledged catastrophe for the province’s elderly population as separate from the overall situation in Quebec, claiming that things are otherwise going well and that the hospital network is stable.

Yet ironically, and disastrously, the nursing home fiasco has spilled back into the province’s health system, as the infected elderly fill wards and fuel coronavirus outbreaks in Montreal hospitals, several of which had to suspend all surgeries this week. New, hospital-based COVID-19 outbreaks are also being reported in so-called clean or “cold” areas.

Several other aspects of Quebec’s situation are cause for serious concern, especially for underprivileged groups. There are reports of an emerging outbreak in the province’s largest prison, again in Montreal, where authorities didn’t bother to conduct tests until last week, even as outbreaks flared in federal penitentiaries.

Meatpacking plants, which employ many refugees and other recent immigrants, have had to be shut down because of significant outbreaks. Montreal-North, one of Montreal’s lowest-income boroughs and home to a significant population of care home and essential service workers, is now at the centre of the city’s biggest outbreak.

Over the past two months, Team Legault’s pandemic management has been decidedly improvisational. The nursing home crisis seemed to blindside Legault, who reacted first by asking for volunteers to fill empty patient-care jobs through a government website.

When his administration couldn’t make that work, in spite of significant interest by well-meaning volunteers, Legault turned to specialist doctors to enlist as nursing home orderlies. Although over 1,000 doctors signed up, Legault nonetheless had to call in the Canadian Armed Forces for more help. All of this took place in real time, via daily news conferences that have turned out to be an exercise in confusion.

It doesn’t take an expert in pandemic management or public health to conclude that this is far from the ideal context in which to start relaxing measures to contain the disease. Nevertheless, the Legault government persists, though already it’s admitting it may have to delay opening up Montreal, a sensible stance endorsed by science.

The World Health Organization (WHO) has outlined six conditions for determining a society’s readiness to ease up on social distancing in the face of coronavirus. Among those conditions is a controlled epidemic, an ability to test and isolate cases, and minimal risk in the most vulnerable settings, such as nursing homes. It’s near impossible to imagine that these conditions have been met in Quebec, and the province’s own academic epidemiologists agree, according to La Presse.

What’s deeply troubling about Quebec’s plans is not necessarily its intention but the lack of a scientific rationale for why this has to happen now, and the way the Legault government proposes doing it. Legault’s recent inept touting of epidemiological principles, such as herd immunity, highlights the tenuous grasp on science among the province’s top deciders.

Dr. Horacio Arruda, the province’s director of public health, has been far from reassuring. “Our ability to treat people in hospital has to be there because it’s clear when we end confinement, there’ll be cases to treat, and hopefully not too many deaths,” he has said. Such ominous statements should keep Quebecers up at night.

Although the impulse to open up is understandable, the costs of a premature, ill-timed restart could be colossal, not only in terms of new outbreaks and lives lost, but in terms of confidence in the economy and, crucially, the government. Already the signs are not good. By making the return to school voluntary and failing to publish any detailed directives to schools, Quebec parents who can manage it are likely to vote on the project by keeping their kids at home.

The only thing worse than a society in shutdown is a society that stutters from shutdown to shutdown for months on end, unpredictably and at tremendous cost.

Where is the data? The panel of experts? The comprehensive testing and containment strategy? The benchmarks for re-evaluating the success of the reopening plan at every stage? The cost-benefit analysis? It seems Quebecers are meant to take these all on a wing and prayer, and blindly trust their leaders.

With an epidemic still underway and no plan in sight for the massive scale-up in testing, random sampling, and contact tracing needed to keep disease spread under control, Quebecers may be the first Canadians to see what a hasty return to work and school can do to a society. No one can reasonably demand a guarantee of success, but citizens should expect their governments to ensure that the odds are on their side.

In Quebec, for now, the virus still seems to be holding the best cards.

The views, opinions and positions expressed by all iPolitics columnists and contributors are the author’s alone. They do not inherently or expressly reflect the views, opinions and/or positions of iPolitics.

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Samuel Freeman is a pediatrician and writer in Montreal. Alan Freeman is an iPolitics columnist and Honorary Senior Fellow at the University of Ottawa’s Graduate School of International and Public Affairs.